|Year : 2015 | Volume
| Issue : 1 | Page : 27-29
Common indications for major cardiothoracic surgeries in Aminu Kano Teaching Hospital, Kano, Nigeria: A 2-year review
Ibrahim Aliyu1, Ismail M Inuwa2
1 Department of Paediatrics Cardiology Unit, Aminu Kano Teaching Hospital, Bayero University Kano, Kano, Nigeria
2 Department of Surgery Cardiothoracic Unit, Aminu Kano Teaching Hospital, Bayero University Kano, Kano, Nigeria
|Date of Web Publication||7-Jan-2015|
Consultant Paediatrician: Department of Paediatrics, Aminu Kano Teaching Hospital, Bayero University Kano, Kano
Source of Support: None, Conflict of Interest: None
Background : Although cardiothoracic surgery has made significant progress in Nigeria, more has to be done in the field of open heart surgery to mitigate the currently experienced need for surgery abroad. This communication highlights the common indications for major cardiothoracic surgeries performed over a 2-year period from November 2011 to October 2013 in Aminu Kano Teaching Hospital, Kano. Highlighted are common cardiothoracic problems often encountered in this region and their outcome. This will therefore form the basis for comparison with what is obtainable in other cardiothoracic centers in the country.
Objectives: To determine the common indications for major cardiothoracic surgeries and their outcome over a 2-year period in the Aminu Kano Teaching Hospital, Kano.
Methodology: Data were retrieved from the operation theater register of our institution and relevant information such as age, sex, indication for surgery, surgical procedure performed and outcome were extracted.
Results : A total of 89 major surgeries were performed during the study period. The subjects comprised of 66 males and 23 females, with a male to female ratio of 3:1. Trauma-related chest injuries constituted the major indication (21.4%), with nine cases being arrow-related chest injury, which was the most common. A single case of pericardectomy was performed. All surgeries were carried out successfully and patients were discharged except for one mortality recorded following intervention of a case of arrow-related chest injury (5.3%).
Conclusion : Trauma-related events were the most common indication for major cardiothoracic surgery in our series. Arrow-related injuries were the most common, and these were seen mostly in males.
Keywords: Cardiothoracic surgery, major surgery, trauma
|How to cite this article:|
Aliyu I, Inuwa IM. Common indications for major cardiothoracic surgeries in Aminu Kano Teaching Hospital, Kano, Nigeria: A 2-year review. J Med Trop 2015;17:27-9
|How to cite this URL:|
Aliyu I, Inuwa IM. Common indications for major cardiothoracic surgeries in Aminu Kano Teaching Hospital, Kano, Nigeria: A 2-year review. J Med Trop [serial online] 2015 [cited 2020 Jan 19];17:27-9. Available from: http://www.jmedtropics.org/text.asp?2015/17/1/27/148686
| Introduction|| |
Cardiothoracic surgery in Nigeria has come of age, ,, but progress has been very slow especially in the field of open heart surgery due to lack of facilities in most of the centers despite the availability of trained cardiothoracic surgeons. , The cardiothoracic unit in Aminu Kano Teaching Hospital was established in 2011, and we handled both acquired and congenital cardiac defects and other cardiothoracic-related disorders. Over the 2-year study period, varieties of cardiothoracic surgical procedures were carried out. We therefore review the common indications for major cardiothoracic surgeries carried out in our center and their outcome from November 2011 to October 2013. This study highlights the common cardiothoracic problems often encountered in this region and their outcome, which will therefore form the basis for comparison with what is obtainable in other cardiothoracic centers in the country.
| Methodology|| |
The main theater operation register and patient file were used and relevant information such as indication for surgery, type of surgery, age, sex and outcome were extracted. Methods documented to have been used to establish the diagnoses, such as chest X-rays, histology, endoscopy, barium swallow and echocardiography, were also noted. Surgical procedures adopted or used for treatment were also noted. Chest tube insertions not requiring general anesthesia were excluded. Major surgery in this communication was defined as operation involving openings into the thoracic and/or abdominal cavities requiring general anesthesia. 
Data were analyzed using SPSS version 16. Percentages and mean values were calculated and data presented as such.
| Results|| |
There were 89 patients studied, consisting of 66 males (75%) and 23 females (25%), with a male to female ratio of 3:1. Age ranged between 7 months and 65 years, with mean age of 35 ± 6.7 years. The distribution of major cardiothoracic procedures within the study period represented in [Table 1] shows that majority of our cases were chest injuries (21.4%), consisting of nail in the heart, chest-related stab wound, road traffic accident-related chest injuries and cases of arrow shot-related injuries. This was followed by empyema thoracic (15.7%), while a single case of constrictive pericarditis who had pericardectomy was managed.
|Table 1: Distribution of common indications for major cardiothoracic surgeries |
Click here to view
All patients were successfully treated except for a single case of arrow in the heart who died, resulting in a mortality of 5.3% [Table 2].
| Discussion|| |
This study clearly showed predominance of male involvement and that chest trauma was the most common indication for major cardiothoracic surgery, which was similar to that documented by Ali et al.,  who also reported a predominance of male cases. However, our findings contrasted with that of Adebonojo et al.,  who reported more female involvement, with infection been the most common indication for cardiothoracic surgery; although our study excluded cases of acute empyema because they all had chest tube insertion under local anesthesia. This may therefore account for the observed disparity. Chronic empyema thoracis was the most common infection documented, and this is probably due to the high prevalence of pyogenic and tuberculous pulmonary infections in our environment.
The incidence of arrow shot injuries are more common in northern Nigeria ,, than in the southern part of the country; this may be related to the increasing incidence of communal clashes in the north, more so if is used for hunting.  However, nine cases - which were as a result of communal clash between farmers and cattle rearers - were documented in this study, which was similar to that reported by Ugwu.  All our patients underwent thoracotomy and only a single death was recorded (5.3%), which is similar to other reports. ,, Chest injuries from other causes, such as nail in the heart,  were also recorded.
Common causes of dysphagia requiring surgery in previous communications in the tropics had been stricture from corrosive esophagitis, esophageal cancer and achalasia cardia. ,, which is similar to our finding.
Patent ductus arteriosus (PDA) is among the common types of acyanotic congenital heart diseases (CHDs) seen  in Aminu Kano Teaching Hospital; however, only six PDA ligations were performed in our center during the study period because our cardiothoracic unit was established very recently and therefore most patients were earlier referred abroad for treatment, which has been the experience in most centers in Nigeria. , Despite the advances in diagnosis of CHD using echocardiography, surgical treatment in Nigeria is still limited, with most patients dying and few patients present in late adulthood, as was seen in a 20-year-old with PDA in our study. This is due to lack of sufficient health facilities, cost of treatment and, at times, parental/caregiver's preference for surgery abroad for a procedure that could be successfully carried out in this country, such as PDA ligation.
All patients had a satisfactory outcome except for a case of arrow in the heart; the patient presented late after attempted removal at the referring hospital failed.
| Conclusions|| |
Trauma-related events were the most common indication for major cardiothoracic surgery. Arrow-related injuries were the most common, and these were more common in males. However, efforts should be made to improve the field of open heart surgery, which will ameliorate the hardship patients go through, especially children with congenital heart problems. Public and private partnership should be encouraged as it is obtained in most countries that have advanced in cardiothoracic surgical care.
| References|| |
Adebonojo SA. Development of open heart surgery in West Africa: A historical perspective. Guest Lecture, 48 th
Annual Scientific Conference, West African College of Surgeons, Freetown, Sierra Leone 2008. Available from: http://www.ifrs-rural.com. [Last accessed on 2014 Jan 01].
Eze JC, Ezemba N. Open heart surgery in Nigeria; indications and challenges. Tex Heart Inst J 2007;34:8-10.
Anyanwu CH, Ihenacho HC, Okoroma EO Nwafo DC, Umeh BU, Okechukwu CC, et al
. Initial experience with open heart surgery in Nigeria. Trop Cardiol 1982;8:123-7.
Falase B, Sanusi M, Majekodunmi A, Animasahun B, Ajose I, Idowu A, et al
. Open heart surgery in Nigeria; a work in progress. J Cardiothorac Surg 2013;8:6. Available from: http://www.cardiothoracicsurgery.org/content/8/1/6. [Last accessed on 2012 Jan 12].
Falase B, Sanusi M, Majekodunmi A, Ajose I, Idowu A, Oke D. The cost of open heart surgery in Nigeria. Pan Afr Med J 2013;14:61.
Earl R. Definition of major and minor surgery. A question and an answer. Ann Surg 1917;65:799.
Ali N, Gali BM. Pattern and management of chest injuries in Maiduguri, Nigeria. Ann Afr Med 2004;3:181-4.
Adebonojo SA, Adebo O, Osinowo O. Pattern of thoracic surgical diseases in Nigeria: Experience at the University College Hospital, Ibadan. J Natl Med Assoc 1978;70:651-7.
Aliyu I, Inuwa I. Arrow in the heart: Our experience. Niger J Cardiol 2014;11:54-6.
Madziga AG. Arrow injuries in North East Nigeria. West Afr J Med 2003;22:106-9.
Nwiloh J, Edaigbini S, Danbauchi S, Aminu MB, Oyati A. Arrow injury to the heart. Ann Thorac Surg 2010;90:289-9.
Ugwu BT. Arrow-chest injuries in north central Nigeria: Case series. West Afr J Med 2008;27:160-3.
Madhok BM, Roy DD, Yeluri S. Penetrating arrow injuries in Western India. Injury 2005;36:1045-50.
VanGurp G, Hutchison TJ, Alto WA. Arrow wound management in Papua New Guinea. J Trauma 1990;30:183-8.
Jacob O. Penetrating thoraco-abdominal injuries with arrows: Experience with 63 patients. Aust N Z J Surg 1995;65:394-7.
Aliyu I, Inuwa I. Nail in the heart of a 4-year-old Nigerian girl: A case report. Niger J Cardiol 2013;10:85-7.
Ahmed AA. The surgical management and outcome of oesophageal cancer in Addis Ababa. Ethiop Med J 2000;38:147-52.
Pindiga HU, Akang EE, Thomas JO, Aghadiuno PU. Carcinoma of the oesophagus in Ibadan. East Afr Med J 1997;74:307-10.
Asani M, Aliyu I, Also U. Pattern of congenital heart diseases among children with Down syndrome seen in Aminu Kano Teaching Hospital, Kano, Nigeria. Niger J Basic Clin Sci 2013;10:57-9.
Asani M, Aliyu I, Kabir H. Profile of congenital heart defects among children at Aminu Kano Teaching Hospital, Kano, Nigeria. J Med Trop 2013;15:131-4.
Ekure EN, Okoromah CN. In-hospital outcome of children referred for cardiac surgery abroad from developing country. Niger J Paediatr 2009;36:80-6.
[Table 1], [Table 2]